The earlier a child initiates alcohol and other drug (AOD) use, the greater the risk of long-range problems. This association persists despite changes in national substance use rates over time, indicating its stability and viability as a target for prevention. At the same time, parent monitoring of youth behavior tends to decrease during the adolescent years, creating a source of risk for not only the early onset of AOD use but also escalation. Thus, programs are needed in parenting behaviors and family relationships that are protective in helping pre-adolescent youth to avoid initiation of AOD use and abuse. This is particularly true of children with psychiatric disorders who are at higher risk for developing AOD disorders than nonpsychiatrically disturbed children. The primary goal of this study is to test the effectiveness of a family-centered intervention to reduce the risk of AOD use among preadolescent children with a history of emotional/behavioral problems. In this application, the families of 80 youths aged 12-14 years, who have not yet begun AOD use but have been referred for mental health care due to psychiatric symptomatology, will be randomly assigned to receive either an individually tailored family program or standard care. The experimental intervention, which is based on the Family Check-Up model (Dishion &Kavanagh, 2003), provides a thorough assessment of family strengths and weaknesses as they relate to future risk for AOD use as well as emotional/behavioral problems, and utilizes principles of motivational interviewing to encourage families to change. Follow-up interviews will be conducted at 6 and 12 months after baseline to assess changes in parenting, AOD use, and other risky behaviors. The proposed research will fill a gap in the existing literature by comparing individually tailored preventive interventions with a population known to be at risk for the eventual development of AOD use disorders. This application addresses Healthy People 2010 indicator 26-10a to "increase the proportion of adolescents not using alcohol or any illicit drugs during the past 30 days." Children with emotional and behavioral problems are at higher risk to develop alcohol and drug problems in adolescence. PUBLIC HEALTH RELEVANCE: We will test whether a family counseling program for preadolescent children with behavior problems reduces the probability these children will initiate use of alcohol and drugs later on as teenagers. The earlier a child initiates alcohol and other drug use, the greater the risk of long-range problems. This family prevention program geared to middle school students receiving mental health care addresses Healthy People 2010 indication 26-10a: "increase the proportion of adolescents not using alcohol or any illicit drugs during the past 30 days."